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vic vrri%,.r UJt: -- <br /> --- ------ <br /> - ------- ----------- ----------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ./ a f <br /> --------- ----- ---------- ---------- -------- --------- (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued __-Z�/Z4 I <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the eron descr ed. <br /> cy <br /> This application is made in compliance with County Ordinance,-No-543 <br /> �. il�� <br /> JOB ADDRESS AND LOCATION"•��t�"--� .,�--�,�-I � rd_ p--��----��_/,t'�/rl --�----------- <br /> �1 �i ! '/� <br /> Owners Name---------- - �7• _`C <br /> ------------------ -------------------'------- -------------------------- ---------------------- Ph <br /> Address. _ � --� -A,-� ---------- <br /> I <br /> - - .........................................................ane <br /> -•- _•------•------------•----_----_ <br /> Contractor's Name---- ------------- j� Q = ,. <br /> I ---------------------- ------------------- ----------------- Phone <br /> Installation will serve: Residence Eg---Apartment House E] Commercial ❑ Trailer Court ❑ Motelf <br /> ❑' Other ❑ <br /> Number of living units: -"�_- Number of bedrooms -9-_ Number of baths <br /> Lot size <br /> Water Supply: Public system e111 ��-"--------• <br /> Y s stemE] Private <br /> [�epth to Water Table _,[''__--- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay H4- A"dobe ❑ Hardpan ❑ <br /> Previous Application Made: (It yes,date___----------------) No ®/'New Construction: Yes 59-"Ro ❑ FHA/VA: Yes W J"No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` L" <br /> Septic ;Ta9k: Distance from nearest well____ ~"A <br /> �/� Dis#ance�,.frorr foun atian__ _. A ®.-� <br /> No. of compartrnents___A Size4',-K-447- � Materia f_ _ r} <br /> "�J , Liquid depth------- , <br /> • . . �. �- ---_Ca otic �"`- <br /> Disposal Field: Distance from nearest well__4- 1...Distance from .foundation_-_ __ <br /> 45-"_____.D�stance to nearest I line _ <br /> Number of lines_ --------- --- --_-_ ength of`"each-line�Q�/�_-_��Alidth of•trench.�A____--- -_-------------------- <br /> Type l <br /> of filter material" <br /> � - ---¢ epth of filter`material ��-----Total length--- 40,f <br /> ---------------- <br /> eepage Pit: Distance to nearest we _.:"�"°" '` "`pistance from oundation____________________DIstance'to nearest lot line..--__.___.___._ I <br /> ❑ Number of pits----------------------Liniri$ material--- -------Size: Diameter--------"---- <br /> -----Depth--------- ------------- <br /> Cesspool: Distance from nearest well----------------- front—foundltion--------------------Lining material_____--_-.--------------------------- <br /> ----- <br /> ___._--_.___. <br /> ❑ Size: Diameter...__ Dent-ham '�) f - -- -_--- -----Liquid Capacity- 4 <br /> gals <br /> � �SDistance from nearest building.__- _".-"__" <br /> Privy: Distance from nearest well. <br /> �� _ - <br /> - r- <br /> ❑ Distance to nearest lot line__ `...'_ «.V : <br /> - ------•------------------ -- �` <br /> I - ---------------------------------- -------- -------- <br /> Remodeling and/or repairing (descr;be):--------------- <br /> - - -- <br /> I -------------------------------------------------- ----------------�----------------------r------------------------------------------------ ------ k+ <br /> --------------------------------' <br /> i-- - -- ------------------------------- <br /> -----=--------------------------------------------------------------------- -------------------------------------------------------------------------------- <br /> hereb certify that I have ' <br /> Y Y prepared #his application and tha# the work will be done in accordance with San Joaquin County �1A' <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) <br /> I A�K - � , <br /> -- ' <br /> ------------------(� <br /> t r Contractor) <br /> BY�-------•------------•------•-----•••----•-----�------------------ - ---------- ---- --6 r - ------._.:Title--- � traces r)------ <br /> (Plot plan, showing size of lot, location of system in relatio wells, buildings, etc., can be placed on reverse side). <br /> 1 s <br /> FOR DEPARTMENT USE ONLY , <br /> APPLICATION ACCEPTED BY <br /> REVIEWEDBY-------r✓ - _..____"_._-s------------------------------------------- -------------------------------------- - DATE---------------------- - <br /> BUILDING PERMIT ISSUED : =-- ------------- --------------- -------------. DATE------ -------- ------- • 4 <br /> " <br /> ---------- --- <br /> -------------------------- --------------- ------------- DATE <br /> Alterations and/or recommendations:___.. <br /> ---------------- <br /> ----------- ------------------------------ ; <br /> 11 <br /> - - - -=----- <br /> ------ <br /> FINAL INSPECTION BY:---- <br /> _ - s <br /> -------- ------------- ---- Date---- ----- -•------�-'----/-�-------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 1.Hasellon Ave. 1300 West Oak Street <br /> 124 Sycamore Street 205 West 4th Street <br /> Stockton,California Lodi,California , Manteca,California <br /> Tracy,California <br /> F,P.C O. <br /> F <br />